[Paralysis caused by carbohydrate during intensive care]. / Lähmungen durch Kohlenhydrate unter der Intensivtherapie.

In 30 septic, edematous intensive care patients a polyneuropathy occurred during treatment of peritonitis, pancreatitis, adult respiratory distress syndrome, or bronchopneumonia; 28 patients developed a complete tetraplegia. We believe this neuropathy to be an important cause of weaning failure. All patients had received parenteral or enteral nutrition with 240-800 g carbohydrate per day. Clinical data indicate that impairment of carbohydrate metabolism was the essential cause of the polyneuropathy. In 14 patients carbohydrate administration was continued; 13 died without neuromuscular recovery. In 16 patients carbohydrate nutrition was reduced to 100-250 g per day after the occurrence of tetraplegia; 13 of these made a full neurologic recovery.

[Anaphylactic shock]. / Der anaphylaktische Schock.

Symptoms, therapy, and outcome of 49 cases of anaphylactic reaction are presented. Epinephrine (0.5-2.0 mg) did not produce any circulatory improvement but induced severe dysrhythmias and even ventricular fibrillation. Neither epinephrine nor prednisolone (2 g) prevented shock development, neurologic sequelae, or fatal outcome. Rapid infusion of 2000 ml 50% colloid (dextran 70 or starch, m.w. 450,000) with 50% Ringer's lactate, however, reliably restored circulation within 30 min. If elevated, airway resistance dropped in conjunction with colloid administration rather than with any other drug. Impairment of the pulmonary circulation is found to be the initial feature of anaphylaxis, manifested by a rise in pulmonary vascular resistance; then stroke volume and systemic blood pressure fall as left heart filling is reduced. Many findings indicate a high blood viscosity with resulting capillary occlusion: rapid clotting; low levels of factors I, II, V, VIII, and X; low plasma protein, which may be only 50% of its normal value; thrombocytopenia; and aggregation of white blood cells with fibrin in small lung vessels. Blood and plasma vanish from the circulation and appear to be sequestered in the pulmonary capillaries as the initial response to the antigen; later, the whole body is affected. Congestion and pain in the lymph nodes indicate that the lymphatic system may also become involved. On the basis of hemoconcentration, a blood volume deficiency in the range of 30% has been calculated.(ABSTRACT TRUNCATED AT 250 WORDS)

[Experiences with 31 anaphylactoid reactions (author's transl)]. / Erfahrungen aus 31 anaphylaktoiden Reaktionen.

31 Anaphylactoid reactions to Dextran, Propanidid, Althesin, Ampicillin and Mepivacaine are reported. By rapid infusion of Ringer lactate and colloid solutions to an amount of 2,000-3,000 ml circulation could be restored in 30 minutes. Prednisolone did not reveal positive effects. After administration of epinephrine in 3 of 4 cases more negative than positive effects were seen.

[Allergic reactions following dextrane infusions (author's transl)]. / Allergische Reaktionen nach Dextraninfusionen

14 allergic reactions to dextran 60 and dextran 75 are reported. In 8 patients the peripheral pulse became impalpable; Medical history and clinical examination did not reveal any predisposition. Histamine liberation is to be discussed. Antihistamines did not protect against allergic reactions of colloid plasma expanders. All the patients were treated with prednisolone and fluids. After rapid infusion of Ringer-lactate and plasma protein solution to an amount of 2000-2775 ml adequate circulation was restored.